Equipment and adaptations: guidance on provision
Guidance outlining the responsibilities of NHS Scotland, Local Authorities, Integration Authorities, and their Housing and Education partners for the provision of equipment and adaptations, with the aim of supporting partnerships, across Scotland, to deliver a more equitable and accessible service.
Moving & Handling
Equipment and adaptations play a critical role in supporting the effective moving & handling of people who are frail or unable to transfer independently. Where an unpaid carer is assisting the person, the correct equipment plays an equally critical role in enabling them to do so safely. The Health & Safety section in this guidance confirms the obligations in relation maintenance, inspection and testing requirements, clearly outlining the responsibilities that agencies hold, as employers of staff, to ensure that equipment is safe for their staff to use. It also highlights the employers responsibilities related to the training of staff, and good practice recommendations for unpaid carers.
It is equally important that the assessment process to determine appropriate equipment and adaptation provision, evidences clearly the views of the person who requires to be moved and handled, and a risk-enabled, person-centred approach is promoted.
- Services need to evidence a minimum intervention ethos, which aims to maximise a person's ability to utilise functional performance, and avoids practice which provides the incorrect equipment , or over prescribes equipment requirements, and 'disables' the person and impacts negatively on their potential wellbeing.
- Risk assessment should promote this ethos, and health & social care partners and care agencies should ensure they work jointly to develop person-centred approaches, as well as supporting the wellbeing of staff involved
To support anyone with a terminal or progressive illness to live at home, and to live to their end of life preferences, it is essential that services act in line with good practice/policy for those with palliative needs, and ensure the service users wishes are central to the decision making for any required equipment provision e.g. often a person in the very 'end of life' stages would prefer to be allowed home to their own bed for their last few days/often hours, with a reduction or removal of formal care provision and more discreet personal care, rather than be cared for in a hospital bed. The risk-enabled Care Plan needs to have explored these options, clearly evidencing the views and wishes of the service user and their family. Any equipment or adaptations which are required, should be provided in a timely way to ensure the service user can be effectively supported.
It is also important that equipment categorised as 'moving & handling', in line with the previous recommendations from the 2009 Guidance, should not be viewed, as only the responsibility of certain professions to provide. Often a multidisciplinary approach is vital to secure the best outcomes for the service user, and to ensure all aspects of the person's needs have been fully considered. A wide range of professionals, across health and social care services, including physiotherapists, nurses, occupational therapists, and social care staff, should be able to assess for and provide moving and handling equipment as required, as part of the service they are providing, and health and social care services should ensure that they avoid arrangements which encourage duplication in the assessment pathways, and inappropriate onward referrals.
Increasingly services have considered the application of 'single-handed care' initiatives whereby they embark on a review and reduction of care packages to require fewer care workers per person, without putting that person's health and wellbeing in harm's way.
This approach recognises concerns about the adoption of generalised practice, which assumes double-handed care as the standard response and default position in all circumstances. The Health & Safety Executive (HSE) are clear in their guidance that blanket solutions should not be applied, and their helpful guide Getting to Grips with Hoisting provides information which highlights the importance of the individual assessment in determining the appropriate number of care workers required to safely move and handle the person.
Unnecessary use of additional care workers has implications, not just in terms of costs, and best use of valuable resources, but more importantly, can be more intrusive for the person who requires moving and handling support, and can prevent them from being encouraged or supported to maximise or regain any functional potential they may have.
Forth Valley health and social care partners have implemented a new programme encapsulating these principles, to ensure a person receives the right amount of care and support in the appropriate environment, whilst creating capacity across the whole system. This is called Prescribing Proportionate Care[PPC]. This approach has already evidenced significant whole system benefits, by changing the equipment, to a type which can be used by a single carer or family members.
We have one patient who went home from acute setting. A really complex patient with complex needs. This person would have had 2-3 paid carers to assist moving and handling, but introducing new equipment has allowed that person to go home with family supporting and no paid care. The patient can go to toilet as and when they need to, rather than waiting on carers arriving, and no intrusion of many carers. Over and above the clear benefits for the patient, the cost saving for that one person was £22,000
AHP Manager for Rehabilitation,
Clacks and Stirling Health and Social Care Partnership
Effective and robust individual risk assessments and care plans, produced with the full involvement of the service user, their family, any unpaid carers, and all relevant professionals, are essential to ensure risks are fully understood from the service user and unpaid carers perspective, and minimised for all involved. As evidenced in the Forth Valley example above, a number of equipment solutions can effectively support single-handed care strategy, and these should be considered as appropriate as part of the local equipment service core stock provision.
With the publication of the Scottish Manual Handling Passport in 2016, health and social care services have recognised the importance of a strategic, partnership approach to the effective provision of manual handling interventions, ensuring safety, and competence, in the workforce, whilst promoting person-centered approaches which maximise independence and choice. Further work is required to encourage more widespread uptake of the tool and partnerships should review their arrangements to encourage standardisation and consistency that this promotes.
- Assessments should evidence the views of the person who requires to be moved and handled and a person-centred, and risk-enabled approach should be promoted.
- Services should apply a minimum intervention ethos, which aims to maximise a person's ability to utilise functional performance and avoids practice which 'disables' the person and impacts negatively on their potential wellbeing.
- For 'end of life' ensure that services act in line with good practice/policy for those with palliative needs and ensure the service users wishes are central to the decision making, avoiding unnecessary equipment provision.
- Ensure that a wide range of professionals are able to assess for and provide moving and handling equipment as required, either to support hospital discharge and/or as part of the service they are providing.
- Services must ensure robust training and refresher training, is in place to support the effective assessment (including positive risk-taking), and use of the equipment.
- Services should ensure they avoid arrangements which encourage duplication in the assessment pathways and inappropriate onward referrals.
- Blanket solutions to moving and handling should not be applied and individual assessment is used to determine the number of care workers required to safely move and handle the person, encouraging the use of single-handed care where appropriate.
- Partnerships should review arrangements to encourage good practice recommendations from the Scottish Manual Handling Passport which aim to help standardise good practice across Scotland.
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